Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
1.
Cochrane Database Syst Rev ; 1: CD013326, 2021 01 20.
Artículo en Inglés | MEDLINE | ID: mdl-33471367

RESUMEN

BACKGROUND: Annually, infections contribute to approximately 25% of the 2.8 million neonatal deaths worldwide. Over 95% of sepsis-related neonatal deaths occur in low- and middle-income countries. Hand hygiene is an inexpensive and cost-effective method of preventing infection in neonates, making it an affordable and practicable intervention in low- and middle-income settings. Therefore, hand hygiene practices may hold strong prospects for reducing the occurrence of infection and infection-related neonatal death. OBJECTIVES: To determine the effectiveness of different hand hygiene agents for preventing neonatal infection in community and health facility settings. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5), in the Cochrane Library; MEDLINE via PubMed (1966 to 10 May 2019); Embase (1980 to 10 May 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 10 May 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were updated 1 June 2020. SELECTION CRITERIA: We included RCTs, cross-over trials, and quasi-RCTs that included pregnant women, mothers, other caregivers, and healthcare workers who received interventions within the community or in health facility settings DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. Primary outcomes were incidence of (study author-defined) suspected infection within the first 28 days of life, bacteriologically confirmed infection within the first 28 days of life, all-cause mortality within the first seven days of life (early neonatal death), and all-cause mortality from the 8th to the 28th day of life (late neonatal death). MAIN RESULTS: Our review included five studies: one RCT, one quasi-RCT, and three cross-over trials with a total of more than 5450 neonates (two studies included all neonates but did not report the actual number of neonates involved). Four studies involved 279 nurses working in neonatal intensive care units and all neonates on admission. The fifth study did not clearly state how many nurses were included in the study. Studies examined the effectiveness of different hand hygiene practices for the incidence of (study author-defined) suspected infection within the first 28 days of life. Two studies were rated as low risk for selection bias, another two were rated as high risk, and one study was rated as unclear risk. One study was rated as low risk for allocation bias, and four were rated as high risk. Only one of the five studies was rated as low risk for performance bias. 4% chlorhexidine gluconate (CHG) compared to plain liquid soap We are uncertain whether plain soap is better than 4% chlorhexidine gluconate (CHG) for nurses' skin based on very low-certainty evidence (mean difference (MD) -1.75, 95% confidence interval (CI) -3.31 to -0.19; 16 participants, 1 study; very low-certainty evidence). We identified no studies that reported on other outcomes for this comparison. 4% chlorhexidine gluconate compared to triclosan 1% One study compared 1% w/v triclosan with 4% chlorhexidine gluconate and suggests that 1% w/v triclosan may reduce the incidence of suspected infection (risk ratio (RR) 1.04, 95% CI 0.19 to 5.60; 1916 participants, 1 study; very low-certainty evidence). There may be fewer cases of infection in the 1% w/v triclosan group compared to the 4% chlorhexidine gluconate group (RR 6.01, 95% CI 3.56 to 10.14; 1916 participants, 1 study; very low-certainty evidence); however, we are uncertain of the available evidence. We identified no study that reported on all-cause mortality, duration of hospital stay, and adverse events for this comparison. 2% CHG compared to alcohol hand sanitiser (61% alcohol and emollients) We are uncertain whether 2% chlorhexidine gluconate reduces the risk of all infection in neonates compared to 61% alcohol hand sanitiser with regards to the incidence of all bacteriologically confirmed infection within the first 28 days of life (RR 2.19, 95% CI 1.79 to 2.69; 2932 participants, 1 study; very low-certainty evidence) in the 2% chlorhexidine gluconate group, but the evidence is very uncertain.   The adverse outcome was reported as mean visual scoring on the skin. There may be little to no difference between the effects of 2% CHG on nurses' skin compared to alcohol hand sanitiser based on very low-certainty evidence (MD 0.80, 95% CI 0.01 to 1.59; 118 participants, 1 study; very low-certainty evidence). We identified no study that reported on all-cause mortality and other outcomes for this comparison. None of the included studies assessed all-cause mortality within the first seven days of life nor duration of hospital stay.  AUTHORS' CONCLUSIONS: We are uncertain as to the superiority of one hand hygiene agent over another because this review included very few studies with very serious study limitations.


Asunto(s)
Infecciones Bacterianas/prevención & control , Higiene de las Manos/métodos , Factores de Edad , Antiinfecciosos Locales/administración & dosificación , Infecciones Bacterianas/epidemiología , Sesgo , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Estudios Cruzados , Desinfectantes para las Manos/administración & dosificación , Desinfectantes para las Manos/efectos adversos , Humanos , Recién Nacido , Enfermería Neonatal/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Jabones/administración & dosificación , Triclosán/administración & dosificación
2.
S Afr Med J ; 110(8): 791-795, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-32880308

RESUMEN

BACKGROUND: Intensive care unit (ICU)-related healthcare-associated infections (HCAIs) are two to three times higher in lower-income countries than in higher-income ones. Hand cleansing and other hygiene measures have been documented as one of the most effective measures in combating the transmission of HCAIs. There is a paucity of data pertaining to hygiene practices in the ICU in developing countries. OBJECTIVES: To determine compliance with hygiene practices among healthcare workers in a tertiary hospital ICU. METHODS: Hygiene practices of healthcare workers in a tertiary academic hospital ICU in Johannesburg, South Africa, were discreetly observed over an 8-week period. Compliance with hand cleansing and other hygiene practices was documented and analysed. Retrospective consent was obtained, and subject confidentiality was maintained. RESULTS: A total of 745 hygiene opportunities were observed. Of the 156 opportunities where handwashing with soap and water was indicated (20.9%), compliance was noted in 89 cases (57.1%), while an alcohol-based hand rub was inappropriately used in 34 cases (21.8%) and no hand hygiene was performed in the remaining 33 cases (21.1%). Of the 589 opportunities where an alcohol-based hand-rub was indicated, it was used in 312 cases (53.0%). Compliance with the donning of disposable surgical gloves, disposable plastic aprons and being 'bare below the elbows' was noted in 114 (90.6%), 108 (71.1%) and 355 (47.7%) opportunities, respectively, where these were indicated. CONCLUSIONS: Overall compliance with hygiene measures among healthcare workers in the ICU was suboptimal in this study, but in keeping with general international trends. Regular retraining of staff, frequent reminders, peer oversight and regular audits may improve compliance.


Asunto(s)
Desinfección de las Manos , Desinfectantes para las Manos/administración & dosificación , Control de Infecciones/estadística & datos numéricos , Unidades de Cuidados Intensivos , Personal de Hospital , Ropa de Protección/estadística & datos numéricos , Centros Médicos Académicos , Auditoría Clínica , Estudios Transversales , Adhesión a Directriz/estadística & datos numéricos , Humanos , Control de Infecciones/normas , Sudáfrica , Centros de Atención Terciaria
3.
Alcohol Alcohol ; 55(4): 354-356, 2020 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-32400852

RESUMEN

AIM: In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram-ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. METHOD: Simple experiments to assess the levels of absorption by each route separately. RESULTS: Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. CONCLUSION: Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Disulfiram/efectos adversos , Disulfiram/química , Etanol/química , Etanol/farmacocinética , Desinfectantes para las Manos/efectos adversos , Desinfectantes para las Manos/farmacocinética , Neumonía Viral/complicaciones , Administración por Inhalación , Pruebas Respiratorias/métodos , Disulfiram/farmacocinética , Disulfiram/uso terapéutico , Etanol/administración & dosificación , Etanol/efectos adversos , Desinfectantes para las Manos/administración & dosificación , Desinfectantes para las Manos/química , Humanos , Pandemias , Absorción Cutánea/efectos de los fármacos
4.
Infect Control Hosp Epidemiol ; 40(11): 1248-1252, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31533869

RESUMEN

BACKGROUND: The effectiveness of alcohol-based hand rub (ABHR) is correlated with drying time, which depends on the volume applied. Evidence suggests that there is considerable variation in the amount of ABHR used by healthcare providers. OBJECTIVE: We sought to identify the volume of ABHR preferred for use by nurses. METHODS: A prospective observation study was performed in 8 units at a tertiary-care hospital. Nurses were provided pocket-sized ABHR bottles with caps to record each bottle opening. Nurses were instructed to use the volume of ABHR they felt was best. The average ABHR volume used per hand hygiene event was calculated using cap data and changes in bottle mass. RESULTS: In total, 53 nurses participated and 140 nurse shifts were analyzed. The average ABHR dose was 1.09 mL. This value was greater for non-ICU nurses (1.18 mL) than ICU nurses (0.96 mL), but this difference was not significant. We detected no significant association between hand surface area and preferred average dose volume. The ABHR dose volume was 0.006 mL less per use as the number of applications per shift increased (P = .007). CONCLUSIONS: The average dose of ABHR used was similar to the dose provided by the hospital's automated dispensers, which deliver 1.1 mL per dose. The volume of ABHR dose was inversely correlated with the number of applications of ABHR per shift and was not correlated with hand size. Further research to understand differences and drivers of ABHR volume preferences and whether automated ABHR dosing may create a risk for people with larger hands is warranted.


Asunto(s)
Infección Hospitalaria/prevención & control , Etanol/farmacología , Desinfección de las Manos/métodos , Desinfectantes para las Manos/administración & dosificación , Enfermeras y Enfermeros , Mano/microbiología , Unidades Hospitalarias , Humanos , Modelos Lineales , Estudios Prospectivos , Centros de Atención Terciaria
6.
J Orthop Surg Res ; 14(1): 166, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31146763

RESUMEN

BACKGROUND: Bone fractures are one of the most common injuries in the USA. Fiberglass tape is a commonly used casting material, and many medical professionals apply adjuvants including liquid hand soap, foam sanitizers, and ultrasound gel in the hopes of improving outcomes relating to ease of molding and eventual strength, lamination, and smoothness of cast material. However, the efficacy of these agents to improve fiberglass cast mechanics has not been scientifically evaluated. The purpose of this study was to assess the mechanical effects of commonly used adjuvants on fiberglass cast materials. METHODS: Studies compared regularly shaped samples of water-activated, untreated fiberglass tape (Ossur Techform Premium) to water-activated fiberglass tape treated with one of three commonly used adjuvants (liquid soap, foam hand sanitizer, or ultrasound gel) during lamination. Material stiffness, yield stress, and ultimate load were measured by 3-point bending. RESULTS: These studies demonstrated that that liquid soap and ultrasound gel did not affect fiberglass tape mechanical properties, but alcohol-based foam sanitizer significantly reduced stiffness (- 32.8%), yield stress (- 33.6%), and ultimate load (- 31.0%) of the cast material as compared to the control group. Regression slopes were not significantly different between groups, suggesting that no adjuvants improved material curing time. CONCLUSIONS: These data suggest that the application of adjuvants is not beneficial and potentially harmful to fiberglass cast behavior. Despite the widespread practice of adjuvant application by medical professionals during casting, results from the current study suggest that use of these agents for structural enhancement of fiberglass casts is not beneficial and should largely be discouraged.


Asunto(s)
Moldes Quirúrgicos , Geles/administración & dosificación , Vidrio , Desinfectantes para las Manos/administración & dosificación , Ensayo de Materiales/métodos , Jabones/administración & dosificación , Moldes Quirúrgicos/normas , Fracturas Óseas/terapia , Vidrio/normas , Humanos
8.
Artículo en Inglés | MEDLINE | ID: mdl-30791457

RESUMEN

Lack of proper hand hygiene among healthcare workers has been identified as a core facilitator of hospital-acquired infections. Although the concept of hand hygiene quality assurance was introduced to Vietnam relatively recently, it has now become a national focus in an effort to improve the quality of care. Nonetheless, barriers such as resources, lack of education, and cultural norms may be limiting factors for this concept to be properly practiced. Our study aimed to assess the knowledge and attitude of healthcare workers toward hand hygiene and to identify barriers to compliance, as per the World Health Organization's guidelines, through surveys at a large medical center in Vietnam. In addition, we aimed to evaluate the compliance rate across different hospital departments and the roles of healthcare workers through direct observation. Results showed that, in general, healthcare workers had good knowledge of hand hygiene guidelines, but not all believed in receiving reminders from patients. The barriers to compliance were identified as: limited resources, patient overcrowding, shortage of staff, allergic reactions to hand sanitizers, and lack of awareness. The overall compliance was 31%; physicians had the lowest rate of compliance at 15%, while nurses had the highest rate at 39%; internal medicine had the lowest rate at 16%, while the intensive care unit had the highest rate at 40%. In summary, it appears that addressing cultural attitudes in addition to enforcing repetitive quality assurance and assessment programs are needed to ensure adherence to safe hand washing.


Asunto(s)
Adhesión a Directriz , Higiene de las Manos/normas , Adulto , Concienciación , Infección Hospitalaria/prevención & control , Higiene de las Manos/métodos , Desinfectantes para las Manos/administración & dosificación , Humanos , Personal de Hospital , Vietnam
9.
Am J Infect Control ; 47(5): 504-508, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30553542

RESUMEN

BACKGROUND: Hand hygiene compliance is low among anesthesia providers in the operating room, which places patients at risk of preventable infections. The goal of this project was to improve hand hygiene compliance by educating anesthesia providers on the World Health Organization's 5 indications for hand hygiene, and increasing access to hand hygiene products in the operating room. METHODS: Observations of hand hygiene in the operating room took place in 3 phases: preimplementation, postimplementation, and 60 days postimplementation. RESULTS: The results showed significant improvements in compliance for each of the 5 indications for hand hygiene as well as overall compliance. Each of the 3 phases of anesthesia demonstrated significant improvement as well. The results also showed a significant decrease in both glove use and use of the portable hand sanitizer device. DISCUSSION: Education and monitoring of hand hygiene among anesthesia providers in the operating room can improve hand hygiene compliance. CONCLUSIONS: Although the use of the portable device declined, further studies could focus on observing single anesthesia providers instead of a preceptor/student combination, and also examine proximity to hand hygiene products in relation to compliance.


Asunto(s)
Anestesia/normas , Desinfección de las Manos/normas , Personal de Salud/normas , Infección Hospitalaria/prevención & control , Adhesión a Directriz/normas , Desinfectantes para las Manos/administración & dosificación , Humanos , Control de Infecciones/normas , Quirófanos/normas , Cooperación del Paciente , Organización Mundial de la Salud
10.
Prehosp Disaster Med ; 33(6): 660-667, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30394244

RESUMEN

BACKGROUND: During the 2014-2015 Ebola outbreak in West Africa, the lack of infection prevention and control (IPC) measures in health care facilities amplified human-to-human transmission and contributed to the magnitude of this humanitarian disaster.Case ReportIn the summer of 2014, the Geneva University Hospitals (HUG; Geneva, Switzerland) conducted an IPC assessment and developed a project based on the local needs and their expertise with the support of the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA; Bern, Switzerland). The project consisted of building local capacity in the production of alcohol-based hand-rub solution (ABHRS) based on the World Health Organization (WHO; Geneva, Switzerland) formula in non-Ebola health facilities at the peak of the outbreak in Liberia (Fall 2014) and during recovery in Guinea (September 2015) to promote safer care. Twenty-one pharmacists in Liberia and 22 in Guinea were trained and one years' worth of laboratory equipment, chemical products, containers for personal use, and bioethanol were delivered to 10 hospitals per country with more than 8,000 100 ml bottles of solution produced at the end of the project.DiscussionHand hygiene using hand-rub solution is a critical component of safer care, especially in health care settings lacking runnable water. Throughout the Ebola outbreak, it was a timely moment to promote hand-rub solution and to reinforce IPC measures in non-Ebola health facilities. During the project implementation, a substantial challenge was the unavailability of bioethanol in Liberia and Guinea. In the long run, sustainability of the production can become an issue as it depends heavily on the local government's financial and political commitment, the capacity to create an on-going demand for hand-rub solution in health facilities, the local purchase and replacement of the materials and chemical products, as well as the availability of continuous local partners' support. CONCLUSION: The project demonstrated that it was feasible to build local capacity in ABHRS production during an emergency and in limited-resource settings when materials and training are provided. Future programs in similar contexts should identify and address the factors of sustainability during the implementation phase and provide regular, long-term technical support. Jacquerioz BauschFA, HellerO, BengalyL, Matthey-KhouityB, BonnabryP, TouréY, KervillainGJ, BahEI, ChappuisF, HagonO. Building local capacity in hand-rub solution production during the 2014-2016 Ebola outbreak disaster: the case of Liberia and Guinea.. Prehosp Disaster Med. 2018;33(6):660-667.


Asunto(s)
Brotes de Enfermedades/prevención & control , Desinfección de las Manos , Desinfectantes para las Manos/administración & dosificación , Fiebre Hemorrágica Ebola/epidemiología , Guinea/epidemiología , Desinfectantes para las Manos/provisión & distribución , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Control de Infecciones , Liberia/epidemiología
11.
J Hosp Infect ; 100(2): 195-201, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30012375

RESUMEN

BACKGROUND: Effective alcohol-based hand rubs (ABHRs) and healthcare worker compliance with hand hygiene guidelines are important in the prevention of infection transmission in healthcare settings. Compliance to hand hygiene guidelines is affected by many factors including education, ABHR availability, time pressure, skin health, and user acceptance of the sensory properties of ABHRs during and after application. AIM: To examine the effect of ABHR format (gel/foam/liquid) and dose (0.7 mL, 1.5 mL, 3 mL) on its sensory properties and acceptability, and to consider how this might affect healthcare workers' hand hygiene compliance. METHODS: Sensory descriptive analysis established key sensory differences between ten market-leading ABHRs (three gels, four foams, two liquids, one aerosol foam). Focus groups reinforced these differences. FINDINGS: All formats were less desirable at the highest dose as they were more difficult to handle than the lower doses. Foams and gels became stickier, less clean-feeling and slower to dry at higher doses. Liquids gave a cleaner, smoother, more moisturized feel, but the increased difficulty in handling and applying the product negated these benefits. Overall, the gel and foam formats were more desirable than the liquid. The key desirable properties include: fast absorption, soft/moisturized hand feel, not sticky, clean feel, and low smell. CONCLUSION: The 1.5 mL dose yielded the most acceptable properties with no extreme negative consequences. The foam provided the benefits of both the liquid and gel and combined them into a more widely acceptable format that may lead to greater hand hygiene compliance.


Asunto(s)
Formas de Dosificación , Adhesión a Directriz , Higiene de las Manos/métodos , Desinfectantes para las Manos/administración & dosificación , Aceptación de la Atención de Salud , Adolescente , Adulto , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Geles/administración & dosificación , Personal de Salud , Humanos , Persona de Mediana Edad , Soluciones/administración & dosificación , Adulto Joven
12.
J Anal Toxicol ; 42(3): 157-162, 2018 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-29206963

RESUMEN

Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) in hair are effective direct biomarkers of ethanol ingestion, whose analytical determination can be used to discriminate between chronic and occasional ethanol intake. Ethanol is a compound widely used in some workplaces (e.g., clinics, hospitals) and is present in considerable amounts in mouthwash for oral cleaning, medications, cosmetic products, hydro-alcoholic disinfectants and antiseptics for hands. This study examined the ethyl alcohol exposure derived from hand disinfectants (in gel form) by simulating the typical occupational situation of medical-health workers (healthcare workers, nurses, surgeons, etc.) who frequently wash their hands with antiseptic sanitizer. Two types of hand disinfectants with 62% w/w of ethanol content were daily applied to the hands of a teetotaler for 20 times a day, for 4 consecutive weeks, thus simulating a typical workplace situation and a cumulative dermal exposure to ethanol of ~1,100 g. Different matrices (head, chest and beard hair, urine) were regularly sampled and analyzed using a ultra high-performance liquid chromatography tandem massspectrometry validated method for EtG and a (HS)SPME-GC-MS validated technique for FAEEs. The data obtained showed that a significant dermal absorption and/or inhalation of ethanol occurred, and that the use of detergents produce urinary EtG concentrations both higher than the cut-offs normally used for clinical and forensic analyses (either 100 and 500 ng/mL, depending on the context). The concentrations of the ethanol metabolites in the keratin matrices were, respectively, below the cut-off of 7 pg/mg for EtG and below 0.5 ng/mg for FAAEs (0.35 ng/mg for ethyl palmitate). In conclusion, the regular use of alcohol-based hand sanitizers can affect the concentration of urinary EtG and lead to positive analytical results, particularly when specimens are obtained shortly after sustained use of ethanol-containing hand sanitizer. On the other hand, direct biomarkers of alcohol abuse in the keratin matrix are capable of distinguishing between ethanol consumption and incidental exposures.


Asunto(s)
Ésteres/metabolismo , Etanol/metabolismo , Ácidos Grasos/metabolismo , Cabello/metabolismo , Desinfección de las Manos/métodos , Desinfectantes para las Manos/metabolismo , Personal de Salud , Exposición por Inhalación , Exposición Profesional , Salud Laboral , Administración Cutánea , Adulto , Abstinencia de Alcohol , Consumo de Bebidas Alcohólicas/metabolismo , Consumo de Bebidas Alcohólicas/orina , Cromatografía Líquida de Alta Presión , Ésteres/administración & dosificación , Ésteres/orina , Etanol/administración & dosificación , Etanol/orina , Ácidos Grasos/administración & dosificación , Ácidos Grasos/orina , Cromatografía de Gases y Espectrometría de Masas , Geles , Desinfectantes para las Manos/administración & dosificación , Desinfectantes para las Manos/orina , Humanos , Masculino , Reproducibilidad de los Resultados , Absorción Cutánea , Detección de Abuso de Sustancias/métodos , Espectrometría de Masas en Tándem
13.
BMC Med Inform Decis Mak ; 17(1): 129, 2017 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-28859640

RESUMEN

BACKGROUND: Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another. METHODS: Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP). RESULTS: A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in Izmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices. CONCLUSION: In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.


Asunto(s)
Infección Hospitalaria/prevención & control , Técnicas de Apoyo para la Decisión , Transmisión de Enfermedad Infecciosa/prevención & control , Higiene de las Manos/métodos , Desinfectantes para las Manos/administración & dosificación , Adulto , Alcoholes/administración & dosificación , Actitud del Personal de Salud , Toma de Decisiones , Femenino , Desinfección de las Manos/métodos , Humanos , Infectología , Masculino , Microbiología , Persona de Mediana Edad , Médicos
15.
Spine (Phila Pa 1976) ; 42(22): 1675-1679, 2017 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-28422796

RESUMEN

MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. STUDY DESIGN: A retrospective cohort study with prospectively collected data. OBJECTIVE: The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. SUMMARY OF BACKGROUND DATA: Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. METHODS: Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. RESULTS: The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264 seconds with the traditional protocol and 160 seconds with the waterless protocol. CONCLUSION: Waterless hand rub with an alcohol based chlorhexidine gluconate solution can be a safe, quick, and cost-effective alternative to traditional hand scrub. LEVEL OF EVIDENCE: 3.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Desinfección de las Manos/normas , Desinfectantes para las Manos/administración & dosificación , Procedimientos Ortopédicos/normas , Infección de la Herida Quirúrgica/prevención & control , Anciano , Anciano de 80 o más Años , Antiinfecciosos Locales/economía , Economía Hospitalaria/normas , Femenino , Desinfección de las Manos/economía , Desinfección de las Manos/métodos , Desinfectantes para las Manos/economía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/economía , Estudios Retrospectivos , Infección de la Herida Quirúrgica/economía , Infección de la Herida Quirúrgica/epidemiología
16.
Am J Infect Control ; 45(6): 626-629, 2017 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-28189410

RESUMEN

BACKGROUND: Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products. METHODS: A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use. RESULTS: Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001). CONCLUSIONS: Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents.


Asunto(s)
Desinfección de las Manos/métodos , Desinfectantes para las Manos/administración & dosificación , Pacientes Internos/psicología , Cooperación del Paciente/psicología , Participación del Paciente/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Desinfección de las Manos/normas , Hospitales/normas , Humanos , Cuidados a Largo Plazo/psicología , Cuidados a Largo Plazo/normas , Masculino , Persona de Mediana Edad , Participación del Paciente/estadística & datos numéricos , Investigación Cualitativa
17.
Eur J Clin Microbiol Infect Dis ; 36(7): 1197-1203, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28132117

RESUMEN

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.


Asunto(s)
Alcoholes/administración & dosificación , Alcoholes/farmacología , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Desinfectantes para las Manos/administración & dosificación , Desinfectantes para las Manos/farmacología , Mano/microbiología , Recuento de Colonia Microbiana , Humanos , Voluntarios
19.
PLoS One ; 11(6): e0157787, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27337036

RESUMEN

Alcohol-based hand sanitizers are widely used to disinfect hands to prevent the spread of pathogens including noroviruses. Alcohols inactivate norovirus by destruction of the viral capsid, resulting in the leakage of viral RNA (virolysis). Since conflicting results have been reported on the susceptibility of human noroviruses against alcohols, we exposed a panel of 30 human norovirus strains (14 GI and 16 GII strains) to different concentrations (50%, 70%, 90%) of ethanol and isopropanol and tested the viral RNA titer by RT-qPCR. Viral RNA titers of 10 (71.4%), 14 (100%), 3 (21.4%) and 7 (50%) of the 14 GI strains were reduced by > 1 log10 RNA copies/ml after exposure to 70% and 90% ethanol, and 70% and 90% isopropanol, respectively. RNA titers of 6 of the 7 non-GII 4 strains remained unaffected after alcohol exposure. Compared to GII strains, GI strains were more susceptible to ethanol than to isopropanol. At 90%, both alcohols reduced RNA titers of 8 of the 9 GII.4 strains by ≥ 1 log10 RNA copies/ml. After exposure to 70% ethanol, RNA titers of GII.4 Den Haag and Sydney strains decreased by ≥ 1.9 log10, whereas RNA reductions for GII.4 New Orleans strains were < 0.5 log10. To explain these differences, we sequenced the complete capsid gene of the 9 GII.4 strains and identified 17 amino acid substitutions in the P2 region among the 3 GII.4 variant viruses. When comparing with an additional set of 200 GII.4 VP1 sequences, only S310 and P396 were present in all GII.4 New Orleans viruses but not in the ethanol-sensitive GII.4 Sydney and GII.4 Den Haag viruses Our data demonstrate that alcohol susceptibility patterns between different norovirus genotypes vary widely and that virolysis data for a single strain or genotype are not representative for all noroviruses.


Asunto(s)
Alcoholes/administración & dosificación , Desinfectantes para las Manos/administración & dosificación , Norovirus/efectos de los fármacos , 2-Propanol/administración & dosificación , Secuencia de Aminoácidos , Proteínas de la Cápside/química , Proteínas de la Cápside/genética , Humanos , Pruebas de Sensibilidad Microbiana , Modelos Moleculares , Norovirus/clasificación , Norovirus/genética , Sistemas de Lectura Abierta , Conformación Proteica , Dominios Proteicos , ARN Viral , Análisis de Secuencia de ADN
20.
J Occup Environ Med ; 58(6): e231-40, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-27281645

RESUMEN

OBJECTIVE: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. METHODS: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. RESULTS: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. CONCLUSION: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.


Asunto(s)
Absentismo , Higiene de las Manos/normas , Costos de la Atención en Salud , Lugar de Trabajo , Femenino , Desinfectantes para las Manos/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Salud Laboral , Servicios de Salud del Trabajador , Estudios Prospectivos , Estudios Retrospectivos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA